Identifying the superior and inferior gluteal arteries during a sacrectomy via a posterior approach.

Background: Identifying the gluteal vessels during a posterior sacrectomy can be challenging. This study defines anatomical landmarks that can be used to approximate the location of the superior and inferior gluteal arteries (SGA and IGA) during a posterior sacrectomy.

Methods: Cadaveric dissection of six fresh adult pelvises to determine the location of the SGA and IGA in relation to the posterior-inferior aspect of the sacroiliac joint (PISIJ), lateral sacral margin and sacrococcygeal joint (SCJ).

Results: The anatomical landmarks are easily palpable. The position of the SGA to the PISIJ is relatively constant as it is tethered by a posterior branch of the artery, which runs inferior to the PISIJ. The IGA position is also relatively constant below the mid-point of the PISIJ and SCJ. The vessels are separated from the sacrospinous/sacrotuberous ligament complex (SSTL) in the perisacral region and as a result an anatomical plane exists anterior to the SSTL, which affords protection of the vessels during SSTL transection. The distance between the vessels and the SSTL increases the more medial the dissection.

Conclusions: The described anatomical landmarks can be used to predict the location of the SGA and IGA during posterior sacrectomy. An anatomical plane exists anterior to the SSTL, which provides protection to the vessels during SSTL transection. Furthermore, the distance between the vessels and the SSTL increases the more medial the dissection, thus, resection of the SSTL as close to the lateral sacral margin as the pathology permits, is advocated.